Provider Demographics
NPI:1588008361
Name:MEDI-CURE HEALTH SERVICES
Entity Type:Organization
Organization Name:MEDI-CURE HEALTH SERVICES
Other - Org Name:MARSHALL MIDDLE SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:KANNIKE-MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD
Authorized Official - Phone:323-295-1136
Mailing Address - Street 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:417
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-295-1136
Mailing Address - Fax:323-295-1071
Practice Address - Street 1:1921 WEST ARROYO STREET
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768
Practice Address - Country:US
Practice Address - Phone:323-295-1136
Practice Address - Fax:323-295-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190636AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190636 ANOtherMEDICAL